In 2010, the Guardian reported on the scandal of the Kosovan black market in organ transplants. Back in 2008 a young Turkish man, Yilman Altun, fainted in a queue at Kosovo's Pristina airport. He had just had a kidney removed and transplanted by the organ ring Medicus. Altun was one among various "desperate Russians, Moldovans, Kazakhs and Turks … lured into the capital 'with the false promise of payments' for their kidneys".

The ring allegedly involved Turkish surgeon Yusuf Sonmez, who was arrested in January 2011, and several eminent Kosovan doctors, and was said to be linked to Kosovan prime minister, Hashim Thaçi. Moreover, further reports claim that in the late 1990s, Sonmez was involved in an organ ring whose source was outright murder. A handful of Serbian captives "were moved to a farmhouse in Fushë-Krujë, a town north of the Albanian capital, Tirana", and were shot in the head so that one or more organs could be removed, undamaged, and sold for transplant.

While this story may represent the shocking nadir of the organ black market, Altun's experience itself showed three key factors common to the trade in human organs. One: he was paid very little of the thousands originally promised (the 74-year-old Israeli recipient had himself paid €90,000). Two: he received little or no effective aftercare – negligence that has been found to make the difference between recovery and a life of permanent, crippling ill-health. Three: the ring that lured him in was thoroughly global, involving wealthy patients from Canada, Germany and Poland, as well as Israel.

The spread of "transplant tourism" has caused countries such as China, Pakistan and the Philippines to pass new laws on paid donations in recent years. In March 2008, the Philippines' health secretary, Francisco Duque, drafted legislation aimed at preventing the country from turning into "the kidney capital of the world". Yet this seemingly enlightened move came only after fierce international pressure had smothered an attempt in the very opposite direction. In January 2008, the health ministry had been considering a plan to facilitate transplant tourism – which "would have made the Philippines the first country in the world to officially sanction the use of poor citizens as living non-related donors for international patients from Asia, the Middle East, Europe and the US".

Even without official sanction, the problem persists in places such as India, Egypt and South America. Jason Keyser tells of how, in the desperate poverty of Cairo's slums, Abdel-Rahman Abdel-Aziz and his wife Asmaa both sold kidneys after being promised $5,400 each. Ultimately, following clandestine operations in a private hospital, "they were stuffed heavily sedated into taxis with just $2,300 each tucked into their clothing". Lack of adequate aftercare effectively crippled the couple, who were then totally unable to work, and left dependent on the man's 70-year-old father. India, meanwhile has seen organ rings broken up by police in 2003, 2011 and 2008. Swindling is sometimes hidden from Indian donors, who are simply unaware that the kidney for which they are paid $1,000 can be sold on for up to $37,500.

One prime destination for these organs may well be the US. The average kidney transplant, writes David Gutierrez, cost $259,000 in the US in 2008, netting between $80,000 and $100,000 in insurance reimbursements for hospitals and doctors. . Gutierrez adds that, in July 2009, 44 US residents were arrested on charges of organ trafficking.

There is clearly no easy solution to either the modern black market in organs, or to local shortages. Some have argued that paid donations should be legalised: partly to regulate them, and partly to ease global supply problems. In China, the state allows organs to be harvested from executed criminals, if they or relatives grant consent. Perhaps an opt-out policy – whereby citizens need to actively decline permission for post-mortem organ donation – would be one partial solution. One clear message of transplant tourism does indeed seem to be that, to stop abuses abroad, we need to improve charity at home.